Abstract:

Objective　To investigate the clinical value of serum procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and pediatric early warning score (PEWS) in the evaluation of prognosis in children with severe pneumonia. Methods　The medical records of 87 children with severe pneumonia hospitalized in Department of Pediatrics, Daye People's Hospital from January 2018 to June 2022 were retrospective analyzed. The children were divided into a death group (22 cases) and a survival group (65 cases) according to whether they died 28 days after hospitalization. The gender, ages, lengths of stay, courses of disease, basic diseases, scores of Acute Physiology Andchronic Health Evaluation Scoring System (APACHE Ⅱ), PCT levels, PEWS, and NLR's of the two groups were compared. The influencing factors were analyzed by multivariate logistic regression. The evaluation value of the combined indicators was analyzed by receiver operating characteristic curve (ROC). χ² and t tests were applied. Results　There were statistical differences in APACHE Ⅱ score, PCT, PEWS, and NLR between the survival group and the death group (t=6.68, 5.93, 6.05, and 6.32; all P<0.05). The APACHE Ⅱ score ≥ 21.53, PCT level ≥3.42 μg/L, PEWS ≥ 2.24, and NLR ≥ 4.76 were risk factors affecting the children's prognosis (all P<0.05). The area under curve (AUC) of serum PCT and NLR combined with pediatric PEWS in the evaluation of the children's prognosis was significantly higher than that of each indicator (all P<0.05). Conclusion　The combination of serum PCT, NLR, and pediatric PEWS has a good clinical value in the evaluation of prognosis in children with severe pneumonia.

Key words:

Procalcitonin, Neutrophil-to-lymphocyte ratio, Pediatric early warning score, Severe pneumonia in children

摘要：

目的　探讨血清降钙素原（PCT）、中性粒细胞与淋巴细胞比值（NLR）联合儿童早期预警评分（PEWS）在小儿重症肺炎预后评估中的临床价值。方法　回顾性分析大冶市人民医院儿科2018年1月至2022年6月期间住院治疗的87例重症肺炎患儿病例资料，根据患儿入院治疗28 d后是否出现死亡分为死亡组和存活组。死亡组22例，男12例、女10例，年龄（4.92±1.21）岁；存活组65例，男37例、女28例，年龄（4.83±1.12）岁。比较两组重症肺炎患儿性别、年龄、住院时间、病程、基础性疾病、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、PCT、PEWS、NLR等，采用多因素logistic回归法分析影响因素，绘制受试者工作特征曲线（ROC）分析联合指标的评估价值。统计学方法采用χ²检验、t检验。结果　存活组和死亡组在APACHEⅡ评分、PCT、PEWS、NLR等方面差异均有统计学意义（t=6.68、5.93、6.05、6.32，均P<0.05）；APACHEⅡ评分≥21.53分，PCT≥3.42 μg/L，PEWS≥2.24分，NLR≥4.76均为影响重症肺炎患儿预后的危险因素（均P<0.05）；血清PCT、NLR联合PEWS评估重症肺炎患儿预后的曲线下面积（AUC）明显大于单一指标的AUC（均P<0.05）。结论　血清PCT、NLR联合PEWS在评估重症肺炎患儿预后方面具有较好的临床应用价值。

关键词:

降钙素原, 中性粒细胞与淋巴细胞比值, 儿童早期预警评分, 小儿肺炎